SMALL INTESTINE Flashcards
Main prognostic factor in small bowel adenocarcinoma
Lymph node invasion
For jejunoileal adenocarcinoma, mortality risk has been linked to …
advanced age, advanced stage, ileal location, recovery of fewer than 10 LN, # of positive nodes
Recurrence of appendicitis in non operative appendicitis mgmt within one year
1/3rd
Overall cost difference between non operative and operative management of appendicitis
Non operative is lower overall
Carcinoid tumor of the appendix 1-2 cm in size. When should you consider R hemi?
- invasion into mesoappendix
- positive margins
- appendiceal base locations
Residual tumor threshold for complete cytoreductive surgery
2.0-2.5 mm
Malignant cells are effectively destroyed by hyperthermia in what temperature range?
41-43 degrees celsius
Location of ampulla of vater on ERCP
12:00-1:00
Location of CBD orifice on ERCP
11:00-1:00
Location of pancreatic duct orifice on ERCP
2:00-4:00
Tx of 1st episode of cdiff, mild to moderate
fidaxomicin 200 mg twice daily for 10 days;
Alternative: Vance 125 mg QID x 10 days
First episode with severe (WBC >15, Cr >1.5) severe c diff tx
Vanco 125 mg PO QID or fidaxomicin 200 mg BID x 10 days
1st episode of cdiff with fulminant (shock, ioleus, toxic megacolon)
Vanco 500 mg QID PO or via NG - if ileus consider adding vanco rectally
Metronidazole 500 mg IV q8h with vanco esp if ileus is present
First relapse of c diff - tx?
If 1st episode was flagyl - give vanco 125 mg PO QID for 10 days
If treated with vanco, do prolonged vanco tx with gradually reduced doses: 125 mg QID for 10-14 days, then 2x daily for a week, then 1x daily for a week, then every 2-3 days for 2-08 weeks OR fidaxomicin 200 mg BID for 10 days
Second or subsequent relapse c diff
VAnco - prolonged tx with gradually reduced doses as described abov e
OR
vanco 125 mg QID for 10 days followed by rifaximin alpha 400 mg TID for 20 days OR fidaxomicin 200 mg BID for 10 days OR fecal microbiota transplant
Screening for CRC in UC
Begin within 8 years of diagnosis, scope every 1-3 years thereafter with >33 random biopsies
Screening for CRC in PSC
Every year
Small bowel mass with calcifications and linear “spoke like” fibrosis of trhe mesentery
Small bowel carcinoid
Increased 5-HIAA excretion in a 24 hour urine collection
Diagnostic but not sensitive for carcinoid unless it is metastatic to liver. Chromograin A is more sensitive. Not highly specific.
How many LN should be removed (ideally) in small bowel carcinoid?
> 7, SEER database showed that this was a/w better outcomes
Where is vitamin B12 complex absorbed?
Ileum. Rsections >60 cm usually result in clinically significant vitamin B12 malabsorption.
Where are bile acids mostly absorbed?
Ileum. Fat malabsorption secondary to bile acid deficiency in those with extensive ileal resection is assoc with increased risk of oxalate kidney stones if colon preserved . Interruption of enterohepatic circulation of bile acids by ileal resection –> decreased hepatic bile acid secretion and altered composition of hepatic bile. Hepatic bile becomes sueprsaturated with cholesterol with subsequent formation of cholesterol crystals and gallstones in gallbladder bile. If >100 cm resected usually there is severe bile acid malabsorption –> steatorrhjea.
Small gastric pouch after roux en y may lead to
pernicious anemia, macrocytic anemia
